Prescription Drugs

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​Eligible Expenses


To determine if a specific drug may be eligible for coverage:

  1. sign in with your Access ID and password,
  2. click on My coverage, and
  3. click on Drug Coverage under the Medical section.

You can get an Access ID and password by calling Sun Life at 1-800-361-6212 or by clicking "Register now" on the sign-in page www.mysunlife.ca/navcanada

Drugs or supplies must be prescribed by a Doctor or Dentist (or other qualified professionals if applicable provincial legislation permits them to prescribe these drugs) and dispensed by a licensed pharmacist or a Doctor.

Read what limitations and exclusions apply to this coverage:

​Eligible Expense ​Limitations
Aerochambers with masks for the delivery of asthma medication For children under six years of age only.
Brand Name Prescription Drugs​ ​Reimbursed at 90% if a generic equivalent does not exist, except if physician completes and submits a Drug Exception form for consideration and approval. If approved by Sun Life reimbursement will be at 95% of brand name cost.
Compounded Prescriptions Regardless of active ingredients​.
Supplies for Diabetes Treatment
  • ​​Hypodermic needles, syringes, and chemical diagnostic aids for treatment of diabetes.
  • Including needles and syringes no earlier than 36 months after purchase of an insulin jet-injector.
Drug-delivery devices to deliver asthma medication Must be integral to the product.
Erectile Dysfunction Drugs Maximum reimbursable expense of $1,3001 for each covered person in any one calendar year.
Injectable drugs Including allergy serums administered by injection​​.
Life-Sustaining Drugs ​​Life-sustaining drugs that may not legally require a prescription, identified in the Therapeutic Guide section of the current Compendium of Pharmaceuticals and Specialties under the following headings:
  • anti-anginal agents
  • antiparkinsonism agents
  • bronchodilators
  • antihyperlipidemic agents
  • hyperthyroidism therapy
  • parasympathomimetic agents
  • tuberculosis therapy
  • anticholinergic preparations
  • anti-arrhythmic agents
  • glaucoma therapy
  • insulin preparations
  • oral fibrinolytic agents
  • potassium replacement therapy
  • topical ensymatic debriding agents
Prescription Drugs
Identified in the Monographs section of the current Compendium of Pharmaceuticals and Specialties as a narcotic, controlled drug, or requiring a prescription.
​​Replacement Therapeutic Nutrients Replacement therapeutic nutrients prescribed by an accredited medical specialist for the treatment of an injury or disease (excluding allergies or aesthetic ailments), provided that no other nutritional alternative exists to support the life of the patient.
Smoking Cessation Aids
​​Specialty Drugs

​​The Enhanced Prior Authorization (EPA) program for Specialty drugs applies to a limited number of drugs and, as its name suggests, prior approval is required for coverage under the program. Once approval has been received from Sun Life Financial you must purchase the specialty drug from a Specialty Preferred Provider identified by Sun Life Financial.

 

In order for drugs in the EPA program to be covered, both you and your doctor need to provide medical information. Please use the EPA form for the specific drug to submit this information. You will be covered for these drugs if the information provided meets the medical criteria as established by Sun Life. If not, your claim will be declined.

Specialty drugs will not be reimbursed if the following two conditions are not met:

  1. if you submit a claim for a specialty drug included in the EPA program and you have not been pre-approved; and,
  2. if you purchase the specialty drug from a pharmacy that is not in the Sun Life Financial Specialty Preferred Provider Network.
Please go to www.mysunlife.ca/navcanada for the form.
Vitamins and Minerals
  • ​Must not be available over the counter; and
  • are prescribed for the treatment of a chronic disease, when the customary practice of medicine considers that these products have proven therapeutic value and when no other alternatives are available to the patient.
Weight Loss Drugs
  • Require a Prescription.
  • Require prior approval.
  • Covered if person is considered obese as defined by the World Health Organization (including prescribed injectable vitamins/dietary supplements if used in conjunction with a weight loss drug program).

1All expenses with a maximum reimbursable amount will be paid at 100% coinsurance.

Published on February 01, 2016